concussions in youth football - brain injury...

Concussions in Youth Football Educating Trainers & Coaches in Sideline Management

Presented by: Mona B. Allan, RN, MScN BIAC September 26, 2012

About Me Mona B. Allan

Clinical Setting

The Issue

Needs Assessment

Project Goals & Objectives

• Awareness Campaign

• Presentation based on N.A.

• Concussion Notice Form

Evaluation Process & Outcomes

Conclusion & Future Recommendations

Outline

Clinical Setting Myers Riders

Ottawa Myers Riders Football Club Non-profit community organization that promotes

amateur tackle football and the development of players aged 6 to 19 years

OVFL (provincial level) NCAFA (local level) 8 Teams

Sandy Ruckstuhl, President

The Issue

The failure to recognize, report, and effectively manage concussions in youth football is due to the lack of knowledge among coaches and trainers.

Football accounted for 11.3% of team sports injuries with 13% being skull & brain injuries (CHIRPP, 2002)*. * does not include concussions treated in community and those not treated at all.

0

5

10

15

20

25

Hockey

Soccer

Basketball

Football

Baseball

The Issue

11.3%

Concussions 13%

Fractures Sprains

Other

Unreported Concussions

Why Concussion not Reported %

Did not think it was serious enough 66.4

Did not want to leave the game 41.0

Did not know it was a concussion 36.1

Did not want to let down teammates 22.1

Other reasons 9.8

Complications for Youth Athletes Complications Short-Term: PTHA, SIS, PCS Long-Term: Alzheimer’s, Parkinson’s, CTE Complications on Academic Performance

Fatigue Difficulty with concentration & attention Difficulty with comprehension & memory Slower processing of new and old information Difficulty converting new learning into memory Problems with processing visual & auditory information Emotional, behavioural, or social symptoms

Best Practice Guideline Consensus Statement on Concussion in Sport

Consensus Statement

Paul McCrory, MBBS, PhD

Willem Meeuwisse, MD, PhD

Karen Johnston, MD, PhD

Jiri Dvorak, MD

Mark Aubry, MD

Mick Molloy, MB

Robert Cantu, MA, MD

2009 Panel Experts

Conceptual Framework W.K. Kellogg Foundation Logic Model

Logic Model Program Planning

Needs Assessment

To identify gaps in knowledge related to the identification and management of concussions. Questionnaire based on current literature 20 true, false, or uncertain formal 1 open-ended question to identify information

that participants wanted included in the educational seminar.

Coach Trainer

Please answer TRUE (T) or FALSE (F). HOWEVER, if you are UNSURE in any way, please select (U). The sole purpose of the questionnaire is for the development of a presentation on concussions.

1. Most concussions involve a loss of consciousness of 1 second or more.

U T F

2. All concussions are traumatic brain injuries. U T F

3. People who get repeated concussions can have permanent brain damage if they try to resume their normal routine too quickly.

U T F

4. Kids who have concussions can feel irritable for no apparent reason but it will not affect their sleeping pattern.

U T F

5. Concussions are less dangerous to youth under the age of 18 because their brain is able to heal more quickly than adults.

U T F

6. There are five grades of concussions that are based on the severity of the blow to the head.

U T F

7. A person who experiences a concussion can “see stars” but won’t get blurred vision.

U T F

8. Players usually recover from a concussion in 7 to 10 days. U T F

9. Studying soon after having a concussion can slow the healing process. U T F

10. A young athlete can safely return to the game right after suffering a concussion

U T F

11. A single blow to the head causes more damage than many smaller ones. U T F

12. There are specific guidelines that allow a player to practice or play a game after a concussion.

U T F

13. A mild jolt to the head can cause the brain to rotate suddenly. U T F

14. Studies show that it usually takes brain cells 24 hours to regain normal function after a concussion.

U T F

15. It is okay to return a young player to the game after having feeling dinged as long as the player’s pupils are not dilated.

U T F

16. Players who have a concussion are not likely to get another one because it only happens by chance during the game.

U T F

17. Concussions produce both mental and emotional symptoms. U T F

18. Concussion symptoms are usually the same for everyone so they are easy to identify.

U T F

19. It is alright for a player to return to play after a mild jolt to the head if they can identify how many fingers the trainer is holding up.

U T F

20. A player who was removed from a game due to a possible concussion may go to practice like everyone else the following day if all the signs and symptoms are gone.

U T F

What would you like to know about concussions?

Survey aspects definition characteristics signs & symptoms managing

Needs Assessment

Results of the Needs Assessment 14 completed surveys [10 coaches, 4 trainers] Gaps included:

Defining concussion Grading concussions Recognizing signs and symptoms Recognizing medical emergencies Identifying steps for safe return to play Prevention of concussions

Project Goals & Objectives

Goal To increase concussion knowledge of coaches and trainers through an educational seminar. Objectives 1. To create awareness about concussions in youth

football & awareness of the educational sessions 2. To develop & implement and educational session 3. To develop a sideline concussion reporting card

Logic Model Program Implementation

Awareness Campaign

Participant Recruitment

1. Emails – kickoff October 21, 2011

2. Poster on the Club website – December 21, 2011

3. Announcement at Club’s AGM – January 26, 2012

Educational Intervention

PowerPoint Presentation Based on gaps identified in Needs

Assessment Endorsed by ThinkFirst, Ottawa Given on 2 different days Interactive forum Evaluation: pre- & post- questionnaire

Concussion Reporting Card

Behavioural Change Cueing for sidelines assessment Inform parents that the athlete has

potentially sustained a concussion Identifies actual symptoms experienced

by the athlete (assist with medical evaluation)

Identify medical emergencies Inform the athletes teachers of

academic repercussions Includes RTP protocols

Evaluation Process

Logic Model

Program

Evaluation

Evaluation Outcomes Trainers Coaches

Logic Model

Program

Evaluation

Evaluation Questionnaires

Pre-seminar Questionnaire 5 questions on existing concussion

knowledge 5 case scenarios to examine

behavioural intention to assess & manage concussions on the sideline

(evaluation of behaviour)

Pre-test Questionnaire

Concussion Clinic Presented to Myers Riders Football Club

Background Information

Coach Trainer Other:

Have a healthcare background

Number of years as a coach or trainer yrs

QUIZ

1. Resting after a concussion is critical because it helps the brain recover.

TRUE or FALSE 2. If the symptoms of a concussion last for weeks, this is called: a) Concussion complication disorder b) Second Impact Syndrome c) Concussive edema d) Post concussion Syndrome e) Chronic Traumatic Encephalopathy (Punch Drunk Syndrome) 3. After sustaining a concussion, a healthcare professional has determined that the athlete can

return to play. What is the second step in this process? a) Start football-specific training activities to increase the athlete’s heart rate b) Start light resistance training c) Start aerobic exercise to increase an athlete’s heart rate d) Begin non-contact physical activity – running, weightlifting routine and football drills e) Reintegrate the athlete in controlled practice sessions

4. Amnesia is a rare side effect of a concussion.

TRUE or FALSE 5. Which of the following would be considered danger signs of a concussion and require taking

an athlete to the emergency department immediately? a) The athlete seems slightly off balance, complains of a headache, did not lose

consciousness, but just “isn’t feeling right” b) The athlete complains of a headache and cannot remember what happened before or

after his hit c) The athlete has slightly slurred speech, and seems to become increasing more confused

and restless d) The athlete complains of a headache and appears dazed or stunned e) Any of the above

Evaluation Outcomes

Concussion Knowledge Years of Experience and Pre-seminar Questionnaire Score

Negative association

Evaluation Outcomes

Concussion Knowledge Pre-seminar and Post-seminar Scores

Pre-seminar mean = 3.02

Post-seminar mean = 4.33

Logic Model

Program

Evaluation

Evaluation Questionnaires

Post-seminar Questionnaire

Same knowledge questionnaire

Same scenarios

Plus self-assessment of perceived

knowledge gained

Post-test Questionnaire

Concussion Clinic Presented to Myers Riders Football Club

Background Information

Coach Trainer Other:

Have a healthcare background

Number of years as a coach or trainer yrs

Learning Self-Assessment Please review the following list of knowledge statements. Give some thought to what you knew before this training and what you learned here today. Circle the number that best represents your knowledge before then after this training.

RATING SCALE: 1 = LOW 3 = MEDIUM 5 = HIGH

BEFORE TRAINING Self-Assessment of Knowledge Related to: AFTER TRAINING

1 2 3 4 5 The definition of concussion and how they can be sustained.

1 2 3 4 5

1 2 3 4 5 How to identify a concussion on the sidelines. 1 2 3 4 5

1 2 3 4 5 Why it is important to recognize and respond properly to a concussion.

1 2 3 4 5

1 2 3 4 5 When to remove a player from the game/practice. 1 2 3 4 5

1 2 3 4 5 When a concussion is a medical emergency. 1 2 3 4 5

1 2 3 4 5 The steps for returning an athlete to play. 1 2 3 4 5

1 2 3 4 5 Overall concussion knowledge 1 2 3 4 5

QUIZ

1. Resting after a concussion is critical because it helps the brain recover.

TRUE or FALSE 2. If the symptoms of a concussion last for weeks, this is called: a) Concussion complication disorder b) Second Impact Syndrome c) Concussive edema d) Post Concussion Syndrome e) Chronic Traumatic Encephalopathy (Punch Drunk Syndrome) 3. After sustaining a concussion, a healthcare professional has determined that the athlete can return to

play. What is the second step in this process? a) Start football-specific training activities to increase the athlete’s heart rate b) Start light resistance training c) Start aerobic exercise to increase an athlete’s heart rate d) Begin non-contact physical activity – running, weightlifting routine and football drills e) Reintegrate the athlete in controlled practice sessions See OVER for page 2

Evaluation Outcomes

Perceived Knowledge Overall

Positive shift in

knowledge gained

Logic Model

Program

Evaluation

Evaluation Questionnaires Pre- & Post- Questionnaire 5 case scenarios to examine

behavioural intentions for managing a suspected concussion on the sidelines

Theory of Planned Behaviour Constructs that predicts intention to perform a behaviour:

Attitudes Subjective norms Perceived behavioural control

Pre-test Questionnaire

QUIZ (page 2)

Each question in this section refers to a game situation. Please circle the number that best represents your intentions. 1. A 17-year old high school football player was tackled in the first half of a varsity game and struck his

head on the ground. When he returns to the sideline, I would ask the player if he has any concussion symptoms.

Disagree 1 2 3 4 5 6 7 Agree

2. A 17-year old high school football player was tackled in the first half of a varsity game and struck his

head on the ground. He clumsily walked back to the huddle unassisted. I am confident that I would call out to the player to take a knee and remove him from play.


3. A 17-year old high school football player was tackled in the first half of a varsity game and struck his

head on the ground. He complains of dizziness and a headache. The player’s symptoms completely resolve in 10 minutes. It is expected of me that I remove and keep the player from returning to the game.


4. A 17-year old high school football player was tackled in the first half of a varsity game and struck his head on the ground. During half-time intermission, he tells you that he has a headache. Benching the player with a possible concussion is:

Worthless 1 2 3 4 5 6 7 Useful

5. I intend to be proactive in assessing players for concussions on the sidelines.


Evaluation Outcomes

Behavioural Intention Overall

Positive shift in intention

to use new knowledge on

the sideline assessment &

management of

suspected concussions

Study Conclusion &

Next Steps

Conclusion

Concussion education is an effective intervention for increasing knowledge acquisition related to: 1) The definition of concussion and how they can be sustained 2) How to identify a concussion on the sidelines 3) Why it is important to recognize and respond to a concussion 4) When to remove a player from the game/practice 5) When a concussion is a medical emergency 6) Steps for returning an athlete to play

Next Steps

1. Evaluating educational programs on sports-related concussions 2. Examining actual behaviour changes following knowledge translation programs. 3. Evaluating the effects of the concussion notice form.

• Assists in facilitating sideline assessment and management? • Provides valuable information of medical evaluation in diagnosis? • Assists parents following a suspected concussion? • Assists school teachers in helping athletes optimize education during their

symptomatic period? • Assists trainers/coaches to reintegrate the athlete into play?

Thank You.

Questions?

concussions in youth football - brain injury...

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